Feature Post: Healthy Expressions

Hello Dysphagia Diners!

We are very excited to post this blog from Brenda Lovette, SLP and holistic health coach. Brenda is passionate about communication and rehabilitation with a holistic approach and focus on healthy living. She has written a summer inspired blog post including a recipe using whole foods especially for our readers! For more great posts from Brenda, please visit her website at www.brendalovette.com. We recommend subscribing to her newsletter!

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Hi! I am Brenda Lovette and I am a Speech Language Pathologist and also a Certified Holistic Health Coach. One of my passions is helping  my clients and their families discover new and holistic ways to stay healthy, even in the presence of medical diagnoses like dysphagia. A healthy life includes many aspects, one of which is a clean healthy diet, rich in plant based whole foods. This part can seem tricky for people with dysphagia, but it doesn’t have to be!

People with dysphagia, especially those using significantly modified diet consistencies, might fall into a rut of eating the same foods over and over again (oatmeal, mashed potatoes, applesauce). Or foods that are prepackaged and convenient but nutritionally sparse and full of preservatives (pudding, store bought “smoothie drinks”, and pastas). No one’s body can thrive like that. Bodies work best when fed with a wide variety of clean, whole, nutrient dense foods. Plus, if you are working on healing or strengthening your body, giving it the fuel it needs for the job is even more crucial.

So what is a “whole” food anyway? A whole food is an item that is as close to it’s unaltered state as possible. In other words, if it can be found in nature, in the ground or (if you eat animal protein) as part of an animal, it counts as a whole food. An apple or an onion? Yes. Apple juice or onion fries? Not so much. Chicken nuggets or microwavable dinners with preservatives and factory produced sauces? Definitely not.

One common misconception is that foods labeled “whole grains” are whole foods. This is a tricky marketing tactic because although the manufacturer may use the entire grain in the product, those grains are often highly processed to get into your whole grain bread, muffins, or cereal. “Whole grain” foods are not inherently bad for you, but don’t be fooled, they often don’t count as a whole food. Some examples of true “whole grains” are brown rice, quinoa, wheat berries, and millet. These end up on your plate looking almost just how they look coming off the plant.

People with dysphagia often feel that they are limited, restricted, and need to give up foods or food-centric activities that they love. Being in this mindset of lack and scarcity can keep the mind and body in a small and scarce place. This is exactly the reason I love the DysDine blog and website, this site can help you see beyond all of the the restrictions and gain sight of all the creative and healthful options that are out there.

I hope you enjoy the following yummy recipes! These popsicles will melt to a thin puree or honey consistency (depending on how you prepare them and how long you let each bite melt in your mouth). They can be a snack or a dessert. And most importantly they contain only whole foods! No sugar added, and no extra ingredients to thicken. Just nutrient dense healthful whole foods.

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Green Pina Colada Pops

Leafy greens are wonderful cleansing foods that are high in fiber which is great for cardiac health and crucial for digestion.
Coconut and greens are high in potassium. This is an important mineral that our body needs, however if you take Coumadin, it’s important to keep your potassium levels stable. Some doctors will say to avoid greens and other high potassium foods, however if you consistently eat greens, fruits, and veggies, you should be OK (and this Popsicle is a small serving anyway). You just want to avoid big spikes and dips in your potassium levels. However check with your dietitian and doctor if you have concerns about your potassium.
1 cup frozen pineapple
3/4 cup coconut milk (purchase in a can)
1/2 cup spinach (packed tightly)
1 banana
1-2 tablespoons of water (or less, just enough to get the ingredients to easily blend)
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Method
Place all ingredients in a very good blender or food processor. Blend until completely smooth. Pour into a popsicle mold or into paper cups and then place Popsicle sticks in the center. Freeze overnight. Release the popsicles from their molds as needed by ripping away the paper cup or running under warm water. Enjoy!

Cherry Garcia Yogurt Pops
Cherries and chocolate are high in antioxidants which have important health benefits.
Yogurt is an excellent source of healthy fat and protein.

Ingredients
1 cup Greek yogurt
1/2 cup cherries (fresh or frozen, NOT cherry pie filling!)
1/3 cup of semisweet chocolate chips
1-2 tablespoons of water (or less, just enough to get the ingredients to easily blend)

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Method
Pour chocolate chips into a very small saucepan, add a tablespoon of yogurt. Turn the heat on low and stir constantly until melted and smooth. Place cherries and water in a very good blender or food processor. Blend until completely smooth. In a small bowl, stir together cherry puree and yogurt. Spoon into a popsicle mold or into paper cups, alternating dollops of yogurt mixture and very thin drizzles of chocolate (if the chocolate is too thick, it will be hard and crunchy when frozen). Then place popsicle sticks in the center. Freeze overnight. Release the popsicles from their molds as needed by ripping away the paper cup or running under warm water. Enjoy!

I hope you enjoy these recipes in good health! Feel free to contact me with questions and feedback, I’d love to hear from you. Visit my website and blog at www.brendalovette.com. Special thanks to my dietitian consultant Olivia Myers!

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Brenda has her own blog, Healthy Expressions: Holistic Health and Communication which can be found here.

To subscribe to the Healthy Expressions newsletter, click here

Dining Out – National Chain: Chili’s Grill & Bar

Dining out with family and friends can be intimidating and overwhelming when dealing with dysphagia, or difficulty swallowing. This post is another installment in our “dining out” series to help those with swallowing difficulties feel more comfortable enjoying meals out in social settings. This post highlights menu selections from Chili’s Grill & Bar, which is a popular casual dining restaurant with +1500 locations across the United States, Canada, and other countries around the world. Chili’s serves American cuisine with a Tex-Mex style influence. Listed below are appropriate options from their menu divided by diet level. Some options are listed with modifications, so be sure to kindly ask your server to accommodate your modifications to adhere to your correct diet level.

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Using guidelines of  The National Dysphagia Diet (NDD), published in 2002 by the American Dietetic Association to make selections for dysphagia diners:

•NDD Level 1: Dysphagia-Pureed (homogenous, very cohesive, pudding-like, requiring very little chewing ability).

•NDD Level 2: Dysphagia-Mechanical Altered (cohesive, moist, semisolid foods, requiring some chewing).

•NDD Level 3: Dysphagia-Advanced (soft foods that require more chewing ability).*

*Taken from ASHA website on dysphagia

NDD level 1 & up:

Mashed Potatoes with Black Pepper Gravy

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Loaded Baked Potato Soup - this soup comes with a sprinkling of bacon, chopped green onions and cheese. To fit in Level 1 requirements of being cohesive and pudding like, ask that they hold all toppings.

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Cheesecake – when enjoying this dessert, avoid eating the crust as this is too solid for a Level 1 consistency

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LDD level 2 & up

Kraft Mac & Cheese – this item is located on the kid’s menu, but don’t let that deter you! It’s still the same familiar mac and cheese, so it’s a good item to order as a side dish or a small entree.

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Black beans  – a specific photo of this item from Chili’s could not be located, but they offer black beans as a side dish option. To be appropriate for NDD level 2, make sure to slightly mash before enjoying.

 

Terlingua Chili – pieces in the chili should be less than 1/2 inch thick and easy to chew/swallow.

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Chicken Enchilada Soup – kindly ask that the chicken be finely diced into smaller than 1 inch pieces and omit crispy tortilla strips.

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Cajun Pasta – kindly ask for the onions to be omitted from this dish, and no toast on the side. You can opt to include the grilled chicken, but be sure to ask that the chicken be diced to 1/4 inch cubes. For a level 3 advanced diet, the chicken can be diced in 1 inch or less pieces.

cajun-pasta

Molten Chocolate Cake – Ice cream melts into a thin liquid, so if on a thickened liquid diet such as nectar or honey, kindly ask your server to not include the ice cream topping.

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Brownie Sundae - Ice cream melts into a thin liquid, so if on a thickened liquid diet such as nectar or honey, kindly ask your server to not include the ice cream topping.

brownie-sundae

LDD level 3 & up

Southwestern Mac ‘n’ Cheese – ask that the chicken be finely cut into smaller than 1 inch pieces.

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Mango-Chile Tilapia – rice should be moist, broccoli should be soft and cut into less than 1 inch pieces

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Salmon with Garlic & Herbs – rice should be moist, broccoli should be soft and cut into less than 1 inch pieces

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Lighter Choice Salmon - rice should be moist, broccoli should be soft and cut into less than 1 inch pieces

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Margarita Fresh Mex Bowl - kindly ask to omit the corn and crispy tortilla strips. Fresh field greens should be shredded. Grilled chicken can be added if diced to less than 1 inch thick.

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Skillet Chocolate Chip Cookie - Ice cream melts into a thin liquid, so if on a thickened liquid diet such as nectar or honey, kindly ask your server to not include the ice cream topping.

skillet-chocolate-chip-cookie

 

Guest Post: Overcoming Concerns About Eating Out with Family and Friends

Hello! My name is Amy DiBattista, and I am a speech-language pathologist with a lot of experience helping people with dysphagia.

I’d like to address an issue that came up time and again for the people with dysphagia whom I treated in skilled nursing and rehabilitation centers: They often expressed hesitation or even extreme worry about eating with family and friends after a dysphagia diagnosis and modified diet, especially when the topic of restaurants was discussed.

The gist of the issue is that many people with dysphagia worry that their dysphagia is a burden on their family and friends. Because of the common natural inclination to avoid burdening others, they withhold themselves from social situations that include eating. Part of the reason for this is, I think, is because many facilities (hospitals, nursing homes, etc.) will deliver a dysphagia diet to your room, but stop short of having the resources necessary to teach a person how to continue the diet at home and in public (one reason why this blog is important)!

The best way to communicate this is through an example, that hopefully any person with dysphagia can relate to. A former patient of mine, Mrs. S., was admitted to a skilled nursing facility with moderate dysphagia following a stroke. She had difficulty chewing, which in turn led to a risk of aspiration. She did very well on a mechanical soft diet, and everything was going well until a day or two before she was discharged home. Mrs. S. confided to me that she was going to miss going out to breakfast on Sundays with her husband. I was surprised to hear her say this, and she explained that she truly felt that she could no longer eat in public. She said that she would have to ask too many questions and sometimes request special orders, and she did not want anyone she was dining with to be embarrassed. She also did not want to impose on the restaurant. (Her husband, to his credit, had been trying to talk her out of this worry and resume their outings for a while.) So, although she was a “successful” dysphagia patient, I did not consider her rehabilitation complete.

Together, we crafted a plan. Mrs. S. and her husband gave me a list of their favorite restaurants, and we carefully dissected the menus, figuring out which foods she could order “as is” and which she would have to have modified. We rehearsed how she would explain her dysphagia (in case she had to) in a dignified way. We talked about how many people have to “watch what they eat” in the U.S., and how in reality, asking for something special in a restaurant would not be as conspicuous as she thought. Finally, we talked a lot about how her dysphagia should not prevent her from enjoying her life. I’m happy to report that Mrs. S. did resume her Sunday breakfasts with her husband.

The take-home message here is that living enjoying the things you used to do with dysphagia diagnosis is possible. Sure, it’s a challenge, but you’re up to it!

 

Amy DiBattista
PhD Candidate, 2014
Department of Psychology
Northeastern University

Mujaddara (Lebanese Lentils with Rice and Caramelized Onions)

NDD Level 3 – Dysphagia Diet Advanced: This dish is appropriate for DDs (Dysphagia Diners) on a Level 3 diet, which may be referred to as “dysphagia diet advanced”, “advanced soft”, or simply “advanced”.

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Those who appeciate flavors from around the world will get a kick out of this dish, which features a mild sweetness with a hint of spice. In Arabic-speaking countries, it is traditionally thought of as “humble but hearty”, because its economical ingredients pack a punch of protein. If you make it at home, please comment below to let us know what you think of it!

Ingredients
1 cup brown or green lentils (not lentils du Puy), sorted for debris and rinsed
1/4 cup extra-virgin olive oil
1 teaspoon ground cumin
1/2 teaspoon black pepper (freshly ground if you have it)
3 medium red or purple onions, thinly sliced
Kosher salt
3/4 cup long-grain rice (basmati is best)
1/2 teaspoon ground cumin
1/2 teaspoon cayenne pepper
1/8 teaspoon ground cinnamon
Squeeze of fresh lemon or lime juice
Plain Greek yogurt, for serving

Directions
1. Place the lentils in a medium saucepan and fill with enough cold water to cover the lentils by about two inches. Bring to a boil over medium-high heat, then turn down to a simmer and cook until the lentils are tender but not mushy, about 20 minutes. Drain and set aside.

Lentils

2. Get a large skillet. Place it over medium-high heat and add the oil. Allow the oil to warm for a minute, then drop in the 1 teaspoon ground cumin and 1/2 teaspoon (freshly ground) black pepper. Cook these together, shaking the pan once in a while, until the cumin darkens a touch (see picture below), about 1 minute.

Cumin and Pepper

3. Add the onions, sprinkle with a dash of salt and cook until they turn a dark caramel brown, stirring often. This will take about 15 minutes. Splash the onions with a little water if they stick to the bottom of the pan. You’ll know they’re done by their deep chestnut color. Be careful not to cook them too long so as to avoid any crispyness or toughness in the dish (this would go against the advanced dysphagia diet recommendations). Sprinkle in the 1/2 teaspoon ground cumin, 1/2 teaspoon cayenne pepper, and 1/8 teaspoon cinnamon. Saute these for about 1 minute.

Caramelized Onions

4. Add the rice and cook, stirring often, until some rice grains start to turn a very light brown. Then, add the cooked lentils, 3 cups of water and 1-1/2 teaspoons of salt. Bring everything to a boil, then turn the heat down to low so that the pan is at a simmer.

Simmering

5. Cover the pan and cook for 30 minutes. The water should be completely evaporated and the rice should be tender. Note: If there’s still too much water in the bottom, put the lid back on and cook for another 5 minutes. When the dish is done, turn off the heat, keep the lid on, and allow the rice to steam undisturbed for about 5 minutes.

Done

6. Taste the dish for seasoning. Serve with a dollop of plain Greek yogurt and a little squeeze of lemon or lime juice.

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This dish was inspired by The Food Network.

 

 

Rise and Shine, it’s Breakfast Time!

Happy Saturday everyone! Breakfast has always been referred to as “the most important meal of the day”, and weekend mornings can provide the optimal time to prepare delicious breakfasts and start your day on the right foot! Enjoying a wonderful breakfast should not be dependent on diet restrictions, so below are some early morning ideas for DDs (Dysphagia diners) of any level.

If you try any of these recipes, feel free to leave a comment and let us know your thoughts!

NDD Level 1: pureed
blueberry-banana-oatmeal-smoothie

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NDD Level 2: mechanically altered (ground)

Banana Yogurt Parfait - for this recipe, and all other parfaits, make sure to avoid topping with the toasted oats
Banana Yogurt Parfait with Maple Oat Topping Recipe

NDD Level 3: mechanically advanced

Hash Brown Egg White Nests - be sure to finely dice all vegetables and meats

Broccoli and Cheese Mini Egg Omelets - as stated above, make sure to finely dice the vegetables after steaming

Creme Brûlée French Toast - make sure to enjoy this moist – add extra syrup if necessary
Creme Brulee French Toast

Easy Whole Wheat Pancakes Recipe

Shamrock Shake

It’s that time of year when people start hearing whispers about the infamous “shamrock shake”. Surprisingly, for the DDs who are on a nectar or honey thick liquid diet, shamrock shakes are a tough smoothie to navigate. They may seem thick and appropriate for your diet, however depending on the base of the shake, you could find yourself aspirating and coughing up a storm. Ice or ice cream based shakes often times melt down to a thin-liquid in your mouth, and by the time it hits your throat, it’s already moving quickly towards your airway.

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In order to get a thick base that won’t thin down in your mouth, freeze some ice cubes of yogurt ahead of time. I think I might use these ice cubes with every milk shake from now on! It’s a great source of protein, so flavorful, and so creamy! I was so surprised at how delicious this milkshake was. And the avocado adds a lot of good fats to provide a healthy boost to your diet.

Ingredients: 

6

2 Avocados

15 oz of Vanilla Greek Yogurt

2.5 oz CoffeeMate Girl Scouts Thin Mint creamer

1 cup coconut milk

4 Leaves of Mint

3 oz of white chocolate (about 1/2 a candy bar) *

Directions: 

Freeze 10 ice cubes of yogurt

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Add the ice cubes, avocado, creamer, milk, and chocolate* to the blender.

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*If you are on a restricted texture diet for solid foods, i.e. soft solids/puree, finely shred the chocolate before adding to the blender, or leave it out all together.

Blend on high for 3-4 minutes or until smooth.

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Your spoon or straw should be able to stand in the middle of your glass without leaning on the edge

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Be sure to drink it while cold. Even though this recipe has thickness in mind, some integrity of the shake can be lost as it warms. Plus, who wants a warm milkshake anyway?

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Happy St. Patrick’s Day!

Valentine’s Day Desserts

Whether you want to make a delicious treat for a DD in your life, or you want to  share a dessert with friends and family, we at DysDine encourage you to celebrate your loved ones this Valentine’s Day. Our blog will provide a few ideas for sweets beyond everyone’s favorite: pudding.

Desserts provide DDs with lots of options. Creamy, smooth fillings! Soft, decadent, moist cakes! Yum! Things to look out for are hard or crunchy shells/crusts, anything with carmel or any type of stickiness, and we want to stay way from nuts, sprinkles, hard chocolates, tough frozen fruits, crumbly cookies/cakes, and other tricky items that may appear in various desserts. Below are a few recipes that can spark your creativity!

NDD 1: Puree Diet

Chocolate Mousse via browneyedbaker.com

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Photo from browneyedbaker.com

Check out her custard, meringue, and pudding desert section for some more ideas, but use digression as some recipes contain chewy textures and are not NDD 1 friendly. Feel free to contact us if you have any questions about how to modify a recipe!

 GF Crustless Cheesecake via Gluten Free Foods

Cheesecake

Photo from glutenfreefoods.com

Crustless No-Bake Cheesecake via CoconutMama

cheesecake1

Topping suggestions :

Strawberry puree with seeds removed

Raspberry puree with seeds removed

Chocolate sauce

Vanilla Caramel Truffel and Banana Parfait  via Lipton Ice Tea

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photo from liptontea.com

NDD 2: Soft Mechanical Diet

We want to make sure that any cakes are very moist and do not crumble in the mouth. Paring drier cakes with sauces and cremes is a good approach.

Molten Lava Cup Cakes  via Crazy For Crust

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Photo From Crazy For Crust

Pillowy Meringue Hearts via Martha Stewart

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Photo From marthastewart.com 

Red Velvet Cheesecake Brownies  via Food Fanatic

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photo from foodfanatic.com

NDD3: Mechanically Advanced Diet

Be sure to watch out for stick substances such as carmel, or hard substances like pecans, pralines, and other nuts.

Easy and Delicious Tiramisu Poke Cake Via Will Cook For Smiles

Tiramisu-Poke-Cake-5-©-willcookforsmiles.com-cake-tiramisu-pokecake-whitecake

photo from willcookforsmiles.com

Louisiana Red Velvet Cheesecake Bars via Kraft

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photo from kraft.com

Happy Valentine’s Day to all our  Dysphagia Diners! 

Crock Pot Loaded Baked Potato Soup

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Diet: Level 1 Puree

Recipe

6 large potatoes (or 9 medium), peeled and cut in 1/2-inch cubes
1 medium onion, chopped
1 quart low-sodium chicken broth
3 cloves garlic, minced
1/4 cup butter
2 1/2 teaspoons salt
1 teaspoon black pepper
1 cup cream or half-and-half cream
1 cup shredded sharp Cheddar cheese
1 cup sour cream (optional)

Diet restrictions: Garnish (optional)
Cooked bacon, crumbled / blend 1 slice Canadian bacon into paste

For a healthier alternative, I used low-fat butter, fat free half-and-half, reduced fat Cheddar cheese, and light sour cream.

photo 1(1)

Directions:

Peel and chop potatoes into 1/2 inch thick cubes

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Add the potatoes, onion, chicken broth, garlic, butter, salt and pepper to the crock pot. Cook on LOW for 8 hours, or HIGH  for 4 hours.

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Once the ingredients are finished cooking in the crock pot, transfer to a blender and puree. Add the cream (or half-and-half) and shredded cheese. Stir until cheese has completely melted into the soup.

Top with 1-2 tablespoons of sour cream. Optional – garnish with sprinkle of cheddar cheese and bacon. To substitute bacon crumbles for puree diet, blend 1 slice Canadian bacon until it forms a paste consistency.

Recipe adapted from: http://www.cdkitchen.com/recipes/recs/2362/Loaded-Baked-Potato-Soup124884.shtml

Dining Out – National Chain: Applebee’s

“Dining Out” blog posts  are designed to provide support to those who wish to remain a participant in social dining outside of the home.  Gathering at a restaurant to share a meal with friends and family is a cornerstone of many social engagements and events. Those with swallowing disorders should not feel excluded from enjoying the company of others over a meal. This post will highlight menu options from Applebee’s to empower readers with information about available choices, so you can confidently go out and place your order.

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Applebee’s has more than 2,000 locations across the America and has expanded into other countries. It’s wide reach and large presence in the restaurant industry make it an easy and convenient choice for many in the United States. Applebee’s is recognized as a casual-dining restaurant, and has an atmosphere and menu items similar to many american-fare restaurants. It is versatile enough to accommodate a variety of occasions or for small meet-ups.Feeling comfortable to dine at Applebee’s would open many opportunities for social dining.

International

Applebee’s website states they  “… are happy to make any modifications or substitutions to your meal that you request…” and that they are “…committed to serving delicious  food – just the way you like it.” Based on their policy, any of the reasonable accommodations below should be honored by the staff at each location.

Using guidelines of  The National Dysphagia Diet (NDD), published in 2002 by the American Dietetic Association to make selections for dysphagia diners:

  • NDD Level 1: Dysphagia-Pureed (homogenous, very cohesive, pudding-like, requiring very little chewing ability).
  • NDD Level 2: Dysphagia-Mechanical Altered (cohesive, moist, semisolid foods, requiring some chewing).
  • NDD Level 3: Dysphagia-Advanced (soft foods that require more chewing ability).*
*Taken from ASHA website on dysphagia

NDD level 1 & Up:

Basil tomato soup - (without croutons)

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Strawberries and Yogurt – (Without strawberries)

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Applesauce -

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NDD Level 2 & Up -

Mashed Potatoes – (Ask that they be well mashed)

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Triple Chocolate Meltdown – a moist cake with sauce is permitted on the NDD L2 diet, however the ice cream would melt to a thin consistency. If you are on a nectar thick or thicker diet, ask them to remove  ice cream from the dish.

Desserts_triple_choc_meltdown

NDD Level 3 & Up 

Macaroni and Cheese – And steamed broccoli as a side

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Savory Cedar Salmon – Politely request that steamed potatoes and vegetables be soft extremely soft

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There are many pasta dishes that can be modified to fit NDD L3 by removing meats and difficult to chew items. For example the below dish Three Cheese Penne with Chicken would be an option if chicken and breadstick are removed. Consider steamed vegetables as a side.

Chicken_three_cheese_penne

*All photos above were taken from Applebees.com

Thanksgiving Meal Ideas

As the cold weather sets in and the holidays are approaching, it’s time to start planning out an important part of the holidays: the food! Living with dysphagia is no reason to not enjoy a scrumptious, mouth-watering meal. With Thanksgiving coming up next week, we’ve included recipes that are perfect for this holiday. Some are Thanksgiving classics, while others are traditional foods with a fun twist. Again, they are categorized as best as possible into their appropriate diet levels.

NDD Level 1 – Pureed

Cumin Cauliflower Puree

Cumin-Cauliflower-Puree

Cranberry Pineapple Sauce

cranberry-pinapple-sauce

Creamed Spinach - to make this recipe Level 1-Puree friendly, make sure to finish by blending until at a “pudding-like” consistency. Otherwise, this recipe is appropriate for Level 2-Mechanically Altered diets.

Lighter-Creamed-Spinach

Creamy Carrot Ginger Soup

skinny-creamy-carrot-ginger-soup

Homemade Applesauce

homemade applesauce

NDD Level 2 – Mechanically Altered

Balsamic Roasted Baby Carrots – Be sure to dice the carrots to less than 1/2 inch thick after cooking till soft.

balsamic roasted carrots

Cranberry Swirl Cheesecake Squares

cranberry-swirl-cheesecake

NDD Level 3 – Mechanically Advanced

Gluten-Free Cheddar Garlic Biscuits

GF Cheesy Garlic Biscuits

Pumpkin Macaroni and Cheese

Pumpkin Mac And Cheese

 

Simple Stuffing

 

Simple Stuffing

Black Bean Brownies

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